Provider Demographics
NPI:1437518917
Name:WILKINS, SHANNON (MMP)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:WILKINS
Suffix:
Gender:F
Credentials:MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3156 LAKESIDE DR
Mailing Address - Street 2:303
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-2859
Mailing Address - Country:US
Mailing Address - Phone:970-260-7638
Mailing Address - Fax:
Practice Address - Street 1:125 N 8TH ST
Practice Address - Street 2:19
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-3530
Practice Address - Country:US
Practice Address - Phone:970-260-7638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-12
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT0003987225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist